Tubular breast cancer is a rare type of breast cancer that starts inside the milk ducts and spreads into the surrounding breast tissue. It gets its name because the cancer cells look like tubes when they are examined under a microscope. Tubular breast cancer makes up about 1-2% of all breast cancers.

Some women might have tubular breast cancer along with the more usual type of breast cancer. This is known as invasive ductal breast cancer and is the most common type of breast cancer. This information is specifically about tubular breast cancer.

Tubular breast cancers are usually small. They are also usually low-grade, which means that the cells look more like normal cells and grow slowly.

The outlook (prognosis) for women with tubular breast cancer, after treatment, is usually excellent.

It’s very uncommon for tubular breast cancer to spread to other parts of the body.

We don’t know the exact causes of breast cancer. But there are certain things, called risk factors, that can slightly increase a woman’s chances of developing breast cancer. These include getting older, starting your periods early and having a late menopause, and having close relatives in your family who’ve had breast cancer.

We don’t know if there are any risk factors that are specifically linked with tubular breast cancer.

Tubular breast cancers may not have any obvious symptoms, so for some women the cancer may be picked up during a routine screening mammogram (breast x-ray). For other women, the main symptom is a small, usually firm feeling, lump in the breast.

Tubular breast cancer is diagnosed in the same way as any type of breast cancer. It may be picked up during a routine screening or it may be that you experience symptoms and go to your GP.

You’ll be referred to a breast clinic to see a specialist. The specialist will ask you some questions and examine your breasts and the lymph nodes (glands) in your armpits. They will then explain which tests you need. Women usually have a mammogram and/or an ultrasound scan. This is followed by a core biopsy and/or a fine needle aspiration. Some women also have tests to check the lymph nodes. These procedures are explained below.

A mammogram (x-ray of the breast)

You’ll be asked to take off your top and bra and will be given a gown to wear before the mammogram. The radiographer (who takes the x-ray) positions you so that your breast is against the x-ray machine. Your breast is then flattened and squashed (compressed) with a flat, clear, plastic plate, which keeps the breast still to get a clear picture. This can be uncomfortable and a little painful but doesn’t take long. You’ll have two mammograms of each breast taken from different angles.

Ultrasound scan

This test uses sound waves to build up a picture of the breast. The person doing the scan puts a gel onto your breast and moves a small hand-held device around the breast. A picture of the inside of the breast shows up on a screen.

Core biopsy

The doctor uses a needle to take a few small pieces of tissue from the lump or abnormal area. First, they will inject some local anaesthetic into the area to numb it. The tissue is sent to the laboratory to test for cancer cells. After a biopsy your breast can be bruised and feel sore for a few days. You can take painkillers until it eases and the bruising should go away within a couple of weeks.

At the laboratory, the tissue is examined under a microscope by a doctor who is an expert in cell types (a pathologist). Tubular breast cancer can easily be diagnosed because of the way the cells look.

Fine needle aspiration (FNA)

This is a quick and simple procedure carried out in the x-ray department. Using a fine needle, your doctor withdraws some cells from the lump or abnormal area into a syringe. The doctor uses x-ray or ultrasound guidance to make sure cells are taken from the right area. The sample is then sent to the laboratory to check for cancer cells.

Tests to check the lymph nodes

Tubular breast cancers occasionally spread to the lymph nodes in the armpit, so some women may have tests to check the lymph nodes. There are different ways of checking the lymph nodes.

You may have an ultrasound of the lymph nodes in your armpit. If any nodes feel swollen or look abnormal on the ultrasound, the doctor will do an FNA or core biopsy of the nodes. Some women have a test known as a sentinel lymph node biopsy (SLNB). This test is carried out at the same time as your planned breast surgery to remove the cancer. SLNB checks whether the sentinel node(s) - the first node(s) that lymph fluid from the breast drains to - contain cancer cells.

If tests show that cancer cells have spread to the nodes, you will usually need surgery to remove all the lymph nodes in the armpit.

Surgery| is the main treatment for tubular breast cancer and is usually followed by radiotherapy to the rest of the breast.

Tubular cancers are almost always sensitive to hormonal therapy. Some women will be given hormonal therapy for a number of years after surgery to reduce the risk of the cancer coming back.

Treatment with chemotherapy or a biological therapy drug called Herceptin® is not usually needed. Very occasionally, these treatments might be given to reduce the risk of a cancer coming back after surgery.

Surgery

You will usually have an operation to remove the lump as well as a margin of healthy tissue around it. This is called a wide local excision or lumpectomy. Tubular cancers are usually small but if the lump is large in proportion to the rest of your breast, or if there is more than one cancer in your breast, the surgeon may advise you to have the whole breast removed (a mastectomy). If you need a mastectomy, your doctors should discuss with you the different options for breast reconstruction| (when a new breast shape is formed). Breast reconstruction can be done at the same time as a mastectomy or later.

Removing the lymph nodes

If tests show that any of the lymph nodes contain cancer cells, you will usually have an operation known as an axillary lymph node dissection (ALND). This procedure involves removing all the lymph nodes in the armpit.

Radiotherapy

Radiotherapy| treats cancer by using high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells.

After a wide local excision, you’ll usually be given radiotherapy to the rest of the breast to reduce the risk of the cancer coming back in that area. In some situations, women may not need radiotherapy if the risk of the cancer coming back is very low. Radiotherapy may not be needed if you’ve had the whole breast removed (mastectomy).

Radiotherapy is usually given for three weeks as a series of short daily sessions, Monday-Friday, with a rest at weekends.

Hormonal therapy

Hormonal therapies| work by lowering the levels of hormones such as oestrogen, or blocking it from attaching to the cancer cells. Oestrogen can encourage some breast cancer cells to grow.

Tests are done first to find out if the cancer cells have receptors, which allow hormones to attach to the cancer cell. Tubular breast cancers usually have a significant amount of receptors for oestrogen. This is known as oestrogen receptor positive (ER positive) breast cancer.

It means the cancer will usually respond well to hormonal therapy. Some women will be given hormonal therapy for a number of years to reduce the chance of tubular breast cancer coming back.

There are different types of hormonal therapies| and they work in different ways. Your doctor or nurse will give you more information about this.

Chemotherapy

Chemotherapy| is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs are carried in the blood and can reach cancer cells anywhere in the body.

If the cancer has spread to the lymph nodes in the armpit, chemotherapy may sometimes be given after surgery to reduce the risk of the cancer coming back.

Chemotherapy may also be used if the cancer comes back in another part of the body. However, because tubular cancers don’t tend to spread outside the breast, this isn’t usually needed.

Chemotherapy is usually given into a vein as an injection or a drip (infusion). You will usually have treatment over a period of about 4-6 months. A combination of two or more chemotherapy drugs is usually given.

Biological therapies

It is rare for women with tubular breast cancer to have HER2 positive breast cancer|, which means that the cancer cells have a large amount of a protein called HER2 on their surface. The doctors will do tests on the cells to find out if you have this type of breast cancer.

Trastuzumab (Herceptin®)| is a biological therapy drug that’s usually used to treat HER2 positive breast cancer. It locks onto the HER2 on the breast cancer cells and stops the cells from growing. Herceptin is given as a drip (infusion) into a vein.

If there is a risk that a HER2 positive tubular breast cancer may come back after surgery, Herceptin may be given in addition to chemotherapy treatment.

Research into treatments for breast cancer is ongoing. Cancer doctors use clinical trials| to assess new treatments. Before any trial is allowed to take place, an ethics committee must have approved and agreed that the trial is in the interest of patients.

You may be invited to take part in a clinical trial. Your doctor must discuss the treatment with you so that you have a full understanding of the trial and what it involves. You may decide not to take part, or withdraw from a trial at any stage. In this situation you will receive the best standard treatment available.

You may have many different emotions|, including anger, resentment|, guilt, anxiety| and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with their condition.

Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it. Our cancer support specialists| can give you information about counselling in your area.

Thanks

With thanks to Mr Douglas Macmillan, Oncoplastic Breast Surgeon and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network|.

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